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Objective: The aim of this study was to assess the prescribing patterns and frequency of use of various drug classes in patients with rheumatoid arthritis in a teaching hospital in Islamabad, Pakistan. Study Design: Descriptive Cross Sectional study. Setting: Medical Outpatient Department of HBS General Hospital, Islamabad. Period: August 2018 to March 2019. Material & Methods: Patients of rheumatoid arthritis were included in the study using non-probability consecutive sampling technique. Socio-demographic details and medication history was collected on pre-designed proforma. Data was analyzed using SPSS version 22. Results: A total of 112 patients were included in the study.108 patients (96.4%) were using disease modifying anti-rheumatic drugs. The most prescribed medication in the patients was methotrexate (n=82, 73%). One disease modifying anti-rheumatic drugs with a steroid was the preferred combination (n=32, 28%). Non-steroidal anti-inflammatory drugs (21%) and steroids (20%) were the other major drug classes among the total medications prescribed. Only one patient included in the study was using biologics. Conclusion: Conventional disease modifying anti-rheumatic drugs in combination with steroids and non-steroidal anti-inflammatory drugs are the preferred therapy in patients of Rheumatoid arthritis in local settings. Methotrexate is the most commonly used disease modifying anti-rheumatic drugs. The use of biological agents remains low as compared to the developed world owing to their high cost.

Objective: This study was designed to evaluate the prevalence of depression in females with primary infertility at a tertiary care hospital in Rawalpindi and identify the factors associated with the condition. Study Design: Descriptive Cross-sectional study. Setting: Infertility Clinic of the Department of Obstetrics and Gyanecology, Benazir Bhutto Hospital, Rawalpindi. Period: February to August 2016. Material & Methods: Females between the ages of 18 and 40 years with primary infertility were included in the study. The presence and severity of depressive symptoms were assessed using the Hamilton Rating Scale for Depression (HAM-D). Socio-demographic details and clinical information was collected on a pre-designed proforma. Results: A total of 102 females were included in the study. The mean age of the patients was 31 years with a STD of ± 4.3 years. 78.4% (n=80) patients were suffering from depression on the basis of HAM-D scores. 18 (17.6%) had mild depression, 34 (33.3%) had moderate depression, 20 (19.6%) had severe depression and 8 (7.8%) patients had very severe depression. An analysis of the socio-demographic factors showed that a majority of the females were educated, housewives and living in extended families. The frequency of depression was significantly associated with a low monthly household income (p=0.046). Conclusion: A high proportion of females with primary infertility suffer from depression. Screening for psychiatric illnesses should be part of the standard evaluation of these patients. Early detection and timely psychological intervention can lead to a significant reduction in long-term morbidity.

Objectives: Patients of rheumatoid arthritis (RA) receiving immunosuppressive drugs have an increased risk of infections such as influenza and are more likely to develop serious complications. WHO and other leading international health organizations recommend influenza vaccination as the most effective preventive strategy in these patients. The aim of our study was to assess the rates of influenza vaccinations in patients of rheumatoid arthritis receiving immunosuppressive drugs in a tertiary care hospital in Islamabad. Study Design: Cross-sectional study. Setting: Medical outpatient unit of the HBS General Hospital, Islamabad. Period: From October 2018 to January 2019. Material & Methods: Included 108 patients of rheumatoid arthritis selected through nonprobability purposive sampling and Patients with at least one year history of Rheumatoid arthritis currently receiving immunosuppressive therapy were included in the study. Socio-demographic details and vaccination history was collected on a pre-designed performa. Data was analyzed using SPSS version 23. Chi square test was applied to ascertain association. Results: Out of the total 108 patients, 80 were females and 28 were males. Average duration of RA among the study sample was 4.6 years. 34% of the patients reported having co-morbid medical condition(s). Only 3% of the patients had received influenza vaccination. 22% of the patients reported severe influenza infection during the preceding season. Lack of awareness about the importance of vaccination was the main reason for low vaccination rate. Conclusion: The rates of influenza vaccination in patients of rheumatoid arthritis receiving immunosuppressive drugs are extremely low in Islamabad. There is an urgent need to raise awareness on this issue among the patients as well as physicians.

Background: More than 150 million people around the globe are diagnosed with urinary tract infections every year. Failure to treat these infections with proper antibiotics can lead to serious complications. The objective of this study was to investigate antibiotic sensitivity and resistance pattern of urinary isolates in type-2 diabetic women with asymptomatic bacteriuria. Material and Methods: This cross-sectional descriptive study was conducted at the HBS General Hospital, Islamabad, from March 2017 to August 2019. A total of 270 females with the diagnosis of type-2 diabetes mellitus were included in the study. Uropathogens were isolated from urine samples and antibiotic sensitivity testing was conducted. Demographic and clinical information was recorded on a pre-designed proforma. The data was analyzed using SPSS version 20. Results: The mean age of the study sample was 50 years (SD ± 5.5) while the mean HbA1c levels were 8.98 g/dL (SD ± 0.8 g/dl). Uropathogens were found in the urine cultures of 106 (39.3%) patients. Extended Spectrum Beta-Lactamase producing (ESBL) Escherichia coli (E. coli) was the most common organism (n=46, 43.4%) which was sensitive to tazobactam, tazocin and co-trimoxazole. Nitrofurantoin was the most effective antibiotic with 62.5% isolates sensitive to it. All of the pathogens were resistant to ciprofloxacin. Conclusions: Asymptomatic bacteriuria is common in type-2 diabetic women with ESBL E. Coli being the most common organism isolated from urine cultures. There is a significant resistance to antibiotics among the uropathogens isolated from these patients.

Objectives: This study was designed to evaluate the frequency of postpartum depression in new mothers at a tertiary care hospital in Faisalabad and identify the factors associated with the condition. Study Design: Cross-sectional study. Setting: Obstetrics and Gynecology Department of Independent University Hospital, Faisalabad. Period: Over a period of three months from February 2018 to May 2018. Material & Methods: Included 213 subjects selected through nonprobability purposive sampling patients who had given birth in the last six months were included in the study. The Punjabi version of Edinburgh Postnatal Depression Scale was used to assess for depression. Socio-demographic and medical information was collected on a pre-designed proforma. Data was analyzed using SPSS version 23. Chi square test was applied to ascertain association. Results: Out of the total 213 participants, 33.8% (n=72) of the study sample were suffering from postnatal depression. The socio-demographic profile of the depressed patients showed that most of them were uneducated (84.72%), housewives (77.78%) living with extended families (68.06%). The difference in the number of depressed women among extended and nuclear families was found to be statistically significant (p-value of 0.004). The study also showed that women suffering from postpartum depression were less likely to breastfeed their babies (p-value 0.046). Conclusion: Postpartum depression was identified in more than one thirds of the females included in this study. This high number should raise an alarm for all health professionals. Detection through mandatory screening and early intervention can prevent the adverse consequences this disorder carries for the mother and the child.